COPD Flashcards
What is the definition of COPD and what is it characterized by?
Define Emphysema
Abnormal and permanent enlargement of the airways distal to the terminal bronchiole.
What are the clinical subtypes of COPD and what are their characteristic features?
List the top 3 RFs for COPD
What is the normal variant and what are the 2 deficiency variants associated with A1AT deficiency?
What is the most common deficiency genotype?
Normal: M
S&Z are deficiency variants
Homozygous ZZ
What is A1ATD?
What are the most common variants?
What is the main tx of A1ATD and how is it administered?
What is the prevalence of COPD in the general population vs in smokers?
Smoker>general
Where is A1AT produced?
What is its role in the body?
Is the risk of COPD dose-dependent with regards to smoking as a RF?
Yes more smoking, more risk
Explain the pathogenesis of non A1ATD COPD.
Explain the pathogenesis of A1ATD COPD.
What are the symptoms you would like to illicit in a history from a COPD patient?
What is Hoover’s sign?
Lower rib cage moves abnormally inwards on inhalation in COPD patients
What is the typical finding on lung auscultation of a patient with COPD?
Prolonged Expiratory phase
+ Bibasal creps
On auscultation of a COPD patient’s chest, you node a loud P2. What does that indicate?
Based on that information, what would you find on auscultation of the lungs?
any other signs to check?
You then perform an ECG of this patient. What findings are you expecting
Loud P2 indicated pulmonary HTN/Cor Pulmonale => Bibasal crepitations
LL pitting oedema
ECG:
Prolonged/tall P wave (RA enlargement)
RBBB + Right axis deviation (RV hypertrophy)
Describe the exam findings you would expect to find in a COPD patient.
What are some differentials for COPD
- A1ATD
- Ddx of asthma (image)
What are the diagnostic investigations for COPD? What findings would you expect?
What ECG findings are consistent of a patient with severe COPD
Signs of Cor Pulmonale (Tall/prolonged p wave + RBBB + Right axis deviation)
Prolonged QT interval with azithromycin
A fib (Part of DECAF)
What investigations should be performed on a patient started on Azithromycin (include findings)?
In COPD what is the regime?
What is the main organism being targeted?
What is another reason for picking Azithromycin although Tazocin also covers the same organism?
ECG (Prolonged QTc >450/460ms)
Pure Tone Audiometry - Sensorineural hearing loss (all macrolides)
Given 3/week (MWF)
Reasons:
1) P. Auroginosa
2) anti-inflammatory properties
How would you investigate a patient with COPD? Justify each.
How can you tell that the chest is hyperinflated on CXR other than the >6 anterior and >10 posterior ribs at MCL?
Flattened diaphragm
What findings would you expect on CXR in COPD?
What findings would you expect on CT thorax in COPD?
- Air trapping
- Emphysematous bullae
- Bronchial wall thickening
What is the use of the GOLD criteria?
What are the components?
Go through the criteria.
Note: There is now a GOLD E (if you see this that means the GOLD E wasnt updated here)
What scoring systems are used in assessing the prognosis of COPD?
DECAF score
BODE score
What age group of COPD patients is the DECAF score used for?
over 35yrs
What is the DECAF score used for in COPD patients?
What are the components of the DECAF score?
How to interpret the results?
It is used to predict hospital mortality in those >35
What the BODE score used for in COPD?
What are the components?
What is the scale used to grade dyspnoea related to activity? Go through the grading.
mMRC!
What is the conservative management of COPD?
What is the acute management of a COPD exacerbation?
What is the mucolytic therapy used in COPD?
If you know any others add them in
Carbocysteine
DNA-ase
Hypertonic nebulized saline
Theophyllines are used in refractory asthma and COPD.
Give an example of Theophylline
What 2 main benefits does it being to these patients?
What are the 2 main negatives?
Phyllocontin
Benefits: Bronchodilator & Anti-inflammatory
Negatives: Requires monitoring & Drug interaction with some antibiotics
Roflumilast is used to reduce exavcerbations in patients with COPD. It can only be used as adjuvant therapy. What type of drug is Roflumilast (Daxas)?
Pde4inhibitor (pde5 is for sildenafil)
What is the pharmacological management of COPD and its escalations? .
What are the indications for long term O2 therapy in a COPD patient?
How long should the patient receive O2 therapy each day?
Talk to me about steroid use in COPD.
What are some SE of steroids and what considerations should be made (Inx, tx)?
Bone protection (calcichew + bisphosphonates) + image
Top 2 SE of SABAs
Top 2 SE of azithromycin
Full management of COPD
Polycythemia is diagnosed if…
HCT >55%
Complications of COPD
re: polycythemia - HCT >55%
